| NPI | 1275913733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NH 20908) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA 10163216) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WI 67919-20) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NH 20908) | |
| Enumeration Date | 2015-05-31 |
| Last Update Date | 2023-11-16 |